Evaluation of the Shared Lives Mental Health Project

Transcription

Evaluation of the
Shared Lives Mental
Health Project
Naomi Harflett and Yasmin Jennings
December 2016
National Development Team for Inclusion
First Floor
30-32 Westgate Buildings
Bath BA1 1EF
T: 01225 789135
www.ndti.org.uk
With thanks to:
We would like to thank everyone who has shared information, data, experiences and views to inform the evaluation of the
Shared Lives Mental Health Project, and the findings presented in this report.
Particular thanks go to the people in Shared Lives arrangements, Shared Lives carers and Shared Lives staff teams who gave
their time to meet with us during the fieldwork. We appreciate your honesty and reflections, as well as the time you’ve
taken to speak with us.
We would also like to thank Shared Lives Plus for facilitating access to data and to Shared Lives schemes and for being a
supportive and collaborative evaluation partner.
Finally, we would like to thank the Cabinet Office for funding this evaluation as part of the funding for the Shared Lives
Mental Health Project.
© 2017 National Development for Inclusion
www.ndti.org.uk
Evaluation of the Shared Lives Mental Health Project, December 2016
2
List of Figures
4
Executive Summary
5
Updated context from Shared Lives Plus
11
1.
Introduction
12
2.
Background to the project
12
3.
The Evaluation
16
4.
Models of Delivery
19
5.
Progress towards outcomes
23
6.
My Shared Lives Outcomes Measurement Tool
48
7.
The costs of Shared Lives
54
8.
Summary: Developing Shared Lives for people with mental ill health – What works? 56
9.
Conclusion and recommendations
Appendix- Theory of Change March 2016
58
62
3
List of Figures
Figure 1 Summary of the seven Shared Lives Mental Health project sites
Figure 2 Number of new Shared Lives arrangements
Figure 3 Number of Shared Lives carers offering mental health support
Figure 4 Counts from the Shared Lives Schemes
Figure 5 Counts from the types of Shared Lives Schemes
Figure 6 Example of question format from My Shared Life tool
Figure 7 Change in respondent feelings in relation to Shared Lives outcome areas
Figure 8 Difference that Shared Lives carers make in relation to Shared Lives outcome areas
Figure 9 Whether respondents feel part of the family or not
Figure 10 Developing Shared Lives for people with mental ill health – what works?
4
Executive Summary
Shared Lives is a form of social care which has historically been used primarily for people
with learning disabilities. In Shared Lives, an adult who needs support or accommodation is
matched with an approved Shared Lives carer, who supports and includes the individual in
their family and community life. The Cabinet Office has funded Shared Lives Plus to deliver a
project to support the development of Shared Lives as an option for people with mental ill
health. The project has supported seven local Shared Lives schemes1 to develop,
demonstrate and market a financially viable and commission ready approach to Shared
Lives mental health support, and to generate learning about what works.
The National Development Team for Inclusion (NDTi) was commissioned to conduct an
independent evaluation of the project. Drawing on data collected through a mixed methods
evaluation approach, this report describes the impact and learning from the project. It is
hoped that the findings reported will be of use to Shared Lives schemes looking to develop
support for people with mental ill health, for Shared Lives Plus supporting schemes to
develop in this area and for commissioners and mental health professionals who are
interested in learning about how Shared Lives can support people with mental ill health.
Progress towards outcomes
Five outcomes covering outcomes for individuals, outcomes for schemes and outcomes for
the mental health sector were developed for the project. Progress towards the outcomes
can be summarised as follows:
Increased understanding of Shared Lives as a viable option for people with mental ill
health in the mental health sector
Including:
a)
b)
Greater awareness and understanding of Shared Lives among people and
organisations working with people with mental ill health; and
better relationships/partnerships with people and organisations working with
people with mental ill health
Through the project, all seven schemes undertook awareness raising activities in order to
promote Shared Lives to professionals and organisations who support people with mental ill
health. Despite some difficulties in making in-roads in making contact with mental health
teams, all schemes made progress in this area. Key to facilitating progress has been finding a
“way in” to mental health teams through making the most of existing contacts or links,
sustained attempts to secure invitations with mental health teams, or making contact with
1
Bradford, Derby, East Sussex, Lincolnshire, North Somerset, Rochdale and Telford and Wrekin
5
those with more strategic responsibility. Where mental health professionals become aware
of what Shared Lives can offer, it is often met with significant enthusiasm. Seeing the
positive outcomes in an individual case rather than hearing about the model in theory is key
to convincing professionals that Shared Lives is a viable option for people with mental ill
health. Harnessing the enthusiasm of mental health professionals to act as ambassadors or
champions within mental health teams is an effective way of promoting Shared Lives.
Increased capacity within the Shared Lives sector to support people with mental ill health
Including:
a)
b)
More people with mental ill health in Shared Lives arrangements
More and better supported Shared Lives carers
The target for the project was for the schemes to grow their mental health support by 100
Shared Lives arrangements across the seven schemes. Given that by the end of September
there were a total of 71 new arrangements across the seven schemes it seems likely that
the target will be met, or close to being met, by the end of December 2016. While all
schemes have made progress towards increasing the number of people in Shared Lives
arrangements, the experience of the Shared Lives schemes was varied, with some schemes
experiencing higher levels of referrals than anticipated, and other schemes struggling to
reach their targets. Key factors in generating higher numbers of referrals were becoming
part of the process where decisions are made about support packages (through being part
of panel meetings, brokerage or being on a preferred provider list) and seizing opportunities
to fulfil demand, such as gaps in certain types of provision or drives to move away from
traditional forms of support.
The target for Shared Lives carer recruitment for the project was to increase the number of
Shared Lives carers offering mental health support by 31 across the seven project schemes.
This was exceeded by the end of September. Across the schemes there was strong and
consistent evidence of Shared Lives carers being supported well by Shared Lives schemes
through recruitment, assessment, induction and ongoing support through placements. This
support is key to the success of individual arrangements and to the Shared Lives model.
Individuals with mental ill health have better choice and control over their lives and their
support, and improved mental health and wellbeing
Across the schemes there was evidence of people in Shared Lives arrangements having
choice and control over whether Shared Lives was the right support option for them, and
considerable evidence of people in Shared Lives arrangements being enabled to pursue
personal interests and activities within the community that they may not have had the
opportunity to do in more traditional settings. Although careful matching between
individual and Shared Lives carer took place in all schemes, there was less evidence of
6
people having a choice of Shared Lives carer or arrangement. For some people in long-term
live-in arrangements, there were also some restrictions on what they were able to do with
their days due to the expectation that they would be out of the house during the daytime in
the week.
The evaluation, qualitative accounts of Shared Lives carers and mental health practitioners,
stories of people in Shared Lives arrangements, and case studies provided by schemes have
provided a rich insight into the impact that Shared Lives can have on the lives of people with
mental ill health. Individual cases have shown how Shared Lives - day support, short breaks
and long-term arrangements - can work to improve general wellbeing and improve mental
health through preventing crisis and hospitalisation, and supporting maintenance and
stability for people with mental ill health. It is not an option that will be right for everyone –
there were a small number of cases which had not worked out – but it is clear that for some
people, at the right point in their mental health recovery, Shared Lives is form of support
that can deliver positive outcomes in terms of mental health and wellbeing.
Shared Lives is part of local mental health promotion and prevention services/support
This outcome reflects the long-term vision that Shared Lives will become part of the
landscape of mental health services or provision in the local areas. Through a combination
of the three support options (day support, short breaks and long-term arrangements),
across the seven schemes there was evidence of Shared Lives working well as a mental
health intervention in the form of: planned prevention; facilitated discharge from hospital;
as a step towards independent living and maintaining stability. In addition, there were a
small number of examples where Shared Lives has been used in responses to
crisis/emergency. However, while the project has demonstrated that Shared Lives can be
part of the landscape of mental health support, there is some way yet to go in all of the
areas before this outcome is realised. As the number of people experiencing positive
outcomes through being in Shared Lives arrangements increases, as champions of Shared
Lives within mental health teams continue to spread the word, and as health and social care
processes change to incorporate consideration of Shared Lives as an option as routine, it
seems likely that this will start to change.
Increased skills, knowledge and contributions of people accessing, experiencing and
delivering Shared Lives
This final outcome cuts across all of the other areas and recognises the broader outcomes
generated through this project – not only for those who are directly receiving support
through Shared Lives but also those delivering Shared Lives as carers, as staff or as
volunteers. There was evidence of an increase in knowledge about mental health both by
Shared Lives staff and Shared Lives carers and a recognition that supporting people within
families and in the community can help to break down the stigma of mental health.
7
The project recorded a total of 356 social action opportunities and 45 volunteering
opportunities that were created as a result of the project. Volunteering opportunities
includes people volunteering to support Shared Lives – for example through promotion,
events, recruitment of carers and being on Shared Lives panels – as well as people in Shared
Lives arrangements volunteering.
Summary: Developing Shared Lives for people with mental ill health – What
works?
There is great variation in how Shared Lives has been delivered to support people with
mental ill health across schemes, and there are many factors which have both challenged
and enabled the development of the support for people with mental ill health. There is
variation in: type of arrangement offered by schemes; the scheme itself (whether
independent or local authority); local health and social care systems; funding mechanisms;
and the support needs of individuals. As a result of such variation, there is no one single
recommended model of delivery. Instead eight key factors for supporting the development
of Shared Lives as a form of support for people with mental ill health have been identified:
Developing Shared Lives for people with mental ill health – what works?
Getting a
“way-in”
Well
supported
carers
Good
matching
Becoming
part of the
process
Developing
Shared Lives
for people
with mental ill
health - what
works?
Compatible
funding
mechanisms
Having
ambassadors
or champions
Seizing
opportunities,
filling gaps
Flexibility
8
1.
Getting a “way-in” – finding a “way in” to mental health teams in order to promote
Shared Lives to potential referring practitioners is crucial. This could be through
making the most of existing contacts or links, sustained attempts to secure e.g.
invitations to mental health team meetings, or going to the ‘top’ and making
contact with those with more strategic responsibility.
2.
Becoming part of the process – although this can be a challenge, especially for
independent providers, becoming integrated into the process where decisions are
made about support packages (whether this is through being part of panel
meetings, brokerage or being on a preferred provider list) is key to growth
happening at any pace.
3.
Having ambassadors or champions – having enthusiastic ambassadors or
champions within mental health teams can be very effective at promoting Shared
Lives.
4.
Seizing opportunities, filling gaps – making the most of local opportunities such as
gaps in certain types of provision or drives to move away from traditional forms of
support – i.e. fulfilling demand – can lead to growth at a faster rate.
5.
Flexibility – being flexible about the type of arrangement that can be offered, to
whom, and being flexible about the role of Shared Lives (e.g. as planned
prevention, facilitated discharge or maintenance) at least at the early stages of
development can open schemes up to a greater number of opportunities.
6.
Compatible funding mechanisms – although this is not always within control of
Shared Lives schemes, especially in-house local authority schemes, to maximise
opportunities, schemes need to ensure the local funding mechanisms (block
contracts, personal budgets etc.) fit with the schemes processes. Ultimately, being
able to accept all forms of funding through whatever route or mechanism will
maximise opportunities.
7.
Good matching – a fundamental element of the Shared Lives model for people with
all support needs is the importance of good matching between Shared Lives carer
the person being supported, and this is no different for people with mental ill
health. Good matching leads to positive outcomes and referrals follow good
outcomes.
8.
Well supported Shared Lives carers – the Shared Lives carer is key to making a
Shared Lives arrangement work. Good support for Shared Lives carers through
recruitment, assessment, induction and ongoing support through placements
ensure they can fulfil their roles.
9
Conclusion
Although all seven project schemes experienced challenges and frustrations in developing
support for people with mental ill health, this evaluation has found evidence of the positive
impact that having support through a Shared Lives arrangement – whether it is day support,
short breaks or long-term arrangements – can have on the lives of people with mental ill
health. Examples have been seen of improvements in general wellbeing and increased
participation in community life, as well as specific examples where people’s mental health
has stabilised and hospital stays have been prevented. Shared Lives will not be right for
everyone, but for the right person, at the right point in their mental health recovery, Shared
Lives can offer an individualised, person-centred form of support at the heart of the
community. As such, it has the potential to play an important role as one option, among
other types of accommodation, short breaks and day support on offer to people with
mental ill health.
10
Updated context from Shared Lives Plus
The Shared Lives Plus mental health development project was funded by the Cabinet Office
for nine months from January to September 2016. This evaluation reports on that
timeframe.
However, the project ran for twelve months to the end of December 2016. The final
outcomes are described below:

7 Shared Lives schemes took part for the full term of the project.

95 new Shared Lives arrangements with a further 11 in progress making a total of
106 Shared Lives mental health support arrangements for the duration of the
project (31 long term, 37 short break, 22 day and 16 unspecified)

119 new and existing Shared Lives carers offering mental health support (28 long
term, 30 short break, 37 day and 24 unspecified).

61 family carers accessed short breaks

572 new social action opportunities, including day, short break and residential

114 new volunteering opportunities

249 mental health organisations contacted

Commission ready pack of 15 documents including a business case, commissioning
guide and training resource.

2 development seminars

3 workshops attended by 52 different people and 24 different schemes.
11
1. Introduction
In February 2016, the National Development Team for Inclusion were commissioned to
undertake an evaluation of the Shared Lives Mental Health Project on behalf of Shared
Lives Plus. Funded by the Cabinet Office, seven local Shared Lives schemes have been
awarded grants of up to £15,000 to support the further development of Shared Lives to
support people with mental ill health2. Operating for 12 months to December 2016, the
project has supported development activities in Shared Lives schemes in the following
areas:







Bradford
Derby
East Sussex
Lincolnshire
North Somerset
Rochdale
Telford and Wrekin
Drawing on data collected through a mixed methods evaluation approach, this report
describes the impact and learning from the project. It is hoped that the findings
reported here will be of use to Shared Lives schemes looking to develop support for
people with mental ill health, for Shared Lives Plus supporting schemes to develop in
this area and for commissioners and mental health professionals who are interested in
learning about how Shared Lives can support people with mental ill health.
2. Background to the project
Shared Lives
Shared Lives (formerly Adult Placement) is a regulated form of social care delivered by
Shared Lives carers who are trained and approved by a registered Shared Lives scheme. In
Shared Lives arrangements, adults (or sometimes young people aged 16 – 17) who need
support or accommodation are matched with compatible Shared Lives carers and families
who support and include the individual in their family and community life. Support is
provided in three types of arrangement:

Long-term accommodation and support: an arrangement where the person moves
into the home of the Shared Lives carer. These arrangements can be an alternative
2
The term ‘mental ill health’ was agreed by those involved in the project as the preferred term to use
to refer to people with lived experience of a range of mental health conditions, and has therefore been
used throughout this report
12
to residential care, supported accommodation, or living with their own family. This
can be a step towards independent living, or could be a longer-term arrangement
for individuals who are unlikely to be able to live independently.

Short breaks: an arrangement where the person stays in the home of the Shared
Lives carer for a limited time. This can be utilised as a form of intermediate care, or
for family carer respite.

Day support: involving the sharing of home and family (and/or community) life of
the Shared Lives carer during the day. This can be used as an alternative to other
forms of day support, such as day centres.
Half of the 12,000 people currently supported by Shared Lives are living with their Shared
Lives carer as part of a supportive household; half visit their Shared Lives carer for day
support or overnight breaks. People in Shared Lives arrangements can also receive a
combination of types of support, for example, someone may receive Shared Lives day
support and also have short breaks with the same Shared Lives carer, or they may live in a
long-term arrangement and have day support with a different Shared Lives carer.
As an alternative to traditional models of social care, including day centres and residential
care, the focus of the Shared Lives approach is on providing people with the support they
need to live life to the full in their community. Shared Lives carers share their own homes
and family lives and support people to develop independent living skills, friendships and
roots in their community, providing person-centred support that is tailored to the specific
needs and choices of individuals. Shared Lives carers are paid a modest amount to cover
their time and expenses.
Shared Lives schemes operate in the majority of local authorities in the UK. Historically,
these arrangements have been used primarily to support people with a learning disability.
More recently local schemes have developed their provision to offer support to people with
other support needs, including older people, people living with dementia, people with
mental ill health, and young people in transition.
Shared Lives Plus
Shared Lives Plus is a national charity and the UK network for shared living approaches to
care and support for adults. Shared Lives Plus helps members to work together to survive
and thrive, influencing local and national policy makers and providing support, training,
events, resources, research programmes and access to insurance. Members include 152
Shared Lives schemes and 5,000 individual Shared Lives carers across the UK.
13
Shared Lives Plus major supporters include the Big Lottery, Nesta, Department of Health and
the Cabinet Office who are providing support to double the size of the Shared Lives sector in
England.
Shared Lives for people with mental ill health
In the two years to 2014/15 the number of people using Shared Lives grew by 27%, to more
than 11,500 people3. Over that same period, the use of Shared Lives by people with mental
ill health increased by 17%, to a total of 760 individuals4. The support continues to be
utilised predominantly by people whose primary support needs are related to a learning
disability (76%), while the proportion of people with mental ill health currently stands at
around 7%.
Current policy context
The current policy context in the NHS and local government provides a strong foundation
from which to develop person-centred community-based support for people with mental ill
health. The Care Act 20145 strengthens the role of personalisation in social care and places
wellbeing as the central principle of the provision of social care. The Five Year Forward View
for Mental Health6 states that people with mental ill health have a right to choice and
control and to receive care that is safe, effective and personal, and emphasises the need for
commissioning for prevention and quality. Integrated Personal Commissioning (IPC) is a new
approach to joining up health, social care and other services at the level of the individual7. It
enables people, carers and families to blend and control the resources available to them
across the system in order to ‘commission’ their own care through personalised care
planning and personal budgets. IPC also supports people to develop their knowledge, skills
and confidence to self-manage through partnerships with the voluntary and community
sector, emphasises the role of community capacity building and advocates greater use of
alternatives to traditional forms of health and social care. People with significant mental
health needs are one of the groups included in the IPC pilots. All of these policies are
centred around the principles of personalisation – individualised and person-centred care
and support that offers individual’s choice and support – principles that are in-line with the
Shared Lives approach to support.
Shared Lives Mental Health Project
3
Shared Lives Plus, (2016), The state of Shared Lives in England report 2016, Liverpool: Shared Lives Plus
Shared Lives Plus, (2016), The state of Shared Lives in England report 2016, Liverpool: Shared Lives Plus
5 Department of Health (2014), The Care Act, London: The Stationary Office
6 The Mental Health Taskforce (2016), The five year forward view for mental health, London: The Mental Health Taskforce
7 www.england.nhs.uk/commissioning/ipc/
4
14
Building on recent growth, the aim of the mental health project is to support the
development of Shared Lives as an option for people with mental ill health. The project has
supported seven local Shared Lives schemes to develop, demonstrate and market a
financially viable and commission ready approach to Shared Lives mental health support,
and to generate learning about what works. Learning from the project will be shared across
the Shared Lives sector to support the growth and development of Shared Lives nationally.
Operating across seven areas in England, each scheme has been awarded a grant of up to
£15,000. The sites and their targets, based on the proposals they submitted for the project
are summarised in the table below. As shown, four of the seven schemes planned to deliver
support to people with mental ill health in all three of the types of arrangement (day
support, short breaks, long-term arrangements), while one scheme (East Sussex) has a sole
focus on long-term support and one other (Bradford) does not plan to offer provision of this
kind as part of the project. Two of the five schemes (Lincolnshire and East Sussex) have
experience of supporting people whose primary support needs are related to mental ill
health that precedes the project. Two schemes are run by independent organisations, the
other five schemes as part of the local authority.
Table 1: Summary of the seven Shared Lives Mental Health Project sites
Scheme
Offering Day
(D), short
break (SB) or
long term (LT)
Number of
new Shared
Lives carers
target
D, SB
Local
authority
or
independe
nt
LA
Number of
people in new
arrangements
(target)
5
History of
supporting
people with
mental ill
health
No
Shared Lives
Bradford
Derby City
Council Shared
Lives
East Sussex
Shared Lives
Scheme
D, SB & LT
LA
9
No
14
LT
LA
4
Yes
7
ASA (Adults
Supporting
Adults),
Lincolnshire
D, SB & LT
I
Yes
15
North Somerset
Shared Lives
D, SB &LT
LA
4
No
10
PossAbilities,
Rochdale
D, SB &LT
I
5
No
13
Telford and
Wrekin Shared
Lives Scheme
D, SB &LT
LA
4
No
10-15
10
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3. The Evaluation
Aims and purpose
The purpose of this evaluation is to identify the impact of the project in the following areas:
1.
The number of additional (new) people with mental health problems provided with
Shared Lives services
2.
The awareness raising activities carried out by local schemes and by Shared Lives
Plus and their effectiveness and impact
3.
The extent and effectiveness of engagement with people with mental health
problems and their families, clinicians and other relevant stakeholders
4.
The tools and resources produced which could be of use for the wider sector
5.
The effectiveness of links made and relationships with local mental health and care
commissioning organisations, referral teams, user-led and family organisations or
groups, volunteering, peer support and other social action related organisations
6.
How Shared Lives helps people take part in social action, both through providing
Shared Lives and through receiving Shared Lives
In addition, the evaluation aims to explore and make recommendations with regards to:
1.
The opportunities for developing and scaling Shared Lives as a mental health
intervention nationally
2.
The barriers to developing and scaling Shared Lives as a mental health intervention
nationally
3.
Any areas of Shared Lives practice which may need developing or changing to
reflect the goals, wishes and needs of people with mental health problems and its
fit with the recovery model and commissioners’ expectations.
Methodology
In order to capture the learning from the project and demonstrate effectiveness and impact,
the evaluation has been designed to reflect a broad range of perspectives. The findings draw
on quantitative and qualitative data and insights gathered through the following methods:
16

Theory of Change workshop, bringing together delivery leads from the seven
project schemes, people with lived experience of mental ill health, Shared Lives
carers, Shared Lives Plus staff and mental health professionals

Initial telephone interviews (total n=16: Shared Lives leads (7), mental health
professionals (3), Shared Lives carers (3), people in Shared Lives arrangements (2),
person with lived experience of mental ill health (1))

Fieldwork visits to four project sites, involving semi-structured (face to face and
telephone) interviews (total n=46)

Shared Lives delivery staff (n=12)

People in Shared Lives arrangements (n=8)

Shared Lives carers (n=11)

Mental health professionals and practitioners (n=8);

Others including representatives from key partners and referring agencies,
people with lived experience of mental ill health and family members (n=7)

Analysis of project monitoring data

Analysis of data collated through the My Shared Lives outcomes measurement tool

Change stories (a type of case study focusing on change to individuals) completed
by schemes

Follow up interviews with Shared Lives leads in non-fieldwork schemes (n=2)
Ethical approval was granted for the research through NDTi’s internal ethics process.
Interview participants were provided with information sheets about the research and
advised that participation was voluntary. In order to encourage openness and honesty and
to enable discussion about aspects that have been challenging or not gone well, the content
of the interviews have been kept confidential within the NDTi research team and quotes in
this report have been kept anonymous. In order to ensure anonymity the findings described
in this report have not been attributed to particular schemes but are reported as general
findings.
Due to some limitations of the data collected through the My Shared Lives outcomes tool
the findings from the tool are reported separately in section 6 alongside discussion of these
limitations.
17
Theory of Change
At the start of the project a Theory of Change was developed through a workshop with a
range of stakeholders for the project. A Theory of Change captures: the issue to be
addressed by the project; the underlying assumptions or rationale behind the project; the
context the project is operating in; the mechanisms or activity which will create the change;
the drivers supporting the change; the desired outcomes for the project and the longerterm impact. The Theory of Change developed for the project can be found in Appendix A.
The outcomes agreed through the workshop are:
1.
2.
3.
Increased capacity within the Shared Lives sector to support people with mental
ill health including:
a.
b.
More and well supported carers
Individuals with mental ill health using Shared Lives have:
a.
Better choice and control over their lives and their support
b.
Improved mental health and wellbeing
Increased understanding of Shared Lives as a viable option for people with
mental ill health in the mental health sector including:
a.
organisations working with people with mental ill health
b.
Better partnerships/relationships with people and organisations working
with people with mental ill health
4.
Shared Lives is part of local mental health promotion and prevention
services/support
5.
Increased skills, knowledge and contributions of people accessing, experiencing
and delivering Shared Lives
The findings of the evaluation are reported in four sections. The first section describes how
Shared Lives has been delivered as a model for people with mental ill health, the second
part reports on progress towards these agreed project outcomes, the third part looks at the
findings from My Shared Lives and the fourth part briefly reflects on the cost of Share Lives
compared to other support options.
18
4.
Models of Delivery
A key aim of the evaluation is to capture learning from the project to support the
development and scaling up of Shared Lives nationally. Shared Lives schemes vary across the
country as does support and services for people with mental ill health and the health and
social care processes and structures that both operate in. Before looking in detail at the
outcomes of the project, this section describes how the funding was used and the range of
ways that Shared Lives has been delivered by the seven schemes to provide support for
people with mental ill health.
The grants could be used flexibly to meet the costs of undertaking additional activities to
develop Shared Lives to support people with mental ill health, with an overarching emphasis
on developing links with clinicians, mental health organisations, user led organisations and
commissioners. The specifics of development activities varied across the seven sites,
although all had targets around the numbers of new people and carers that they intend to
reach. Across the schemes the funding has been used for:

Promotion and marketing of Shared Lives

Recruitment of new Shared Lives carers

Induction of new Shared Lives carers

Resourcing staff time to develop relationships with mental health teams and
organisations

Resourcing staff time to develop processes

In one case trialling a “try before you buy” voucher scheme
Across the seven schemes all three types of Shared Lives arrangements were used to
support people with mental ill health:

Long-term accommodation and support: across the schemes there were examples
of people in long-term arrangements as an alternative to residential care,
supported accommodation, inpatient care, living with their own family or living
independently. There were examples of people using long-term Shared Lives
arrangements as a step towards independent living, and as a longer-term
arrangement for people who are unlikely to be able to live independently.
19

Short breaks: across the schemes there were examples of short breaks being used
for carer respite, for crisis prevention, to facilitate hospital discharge and in a small
number of cases as a crisis intervention as an alternative to inpatient care.

Day support: across the schemes there were examples of day support being used
as an alternative to other forms of day support such as day centres and as a way to
support independent living.
There were several examples of people accessing a combination of these forms of support,
for example living with one Shared Lives carer in a long-term arrangement and having day
support and short breaks from another, or having regular day support and planned short
breaks with the same Shared Lives carer. There was also movement between these
arrangements, for example someone who has been in a long-term arrangement, moving on
to living independently and receiving day support from the same Shared Lives carer to
provide support to maintain independence. The indications are that this flexibility, the
ability to change arrangements as someone’s mental health and support needs fluctuate,
works well to support people with mental ill health.
Through a combination of the three support options, across the seven schemes there was
evidence of Shared Lives working as a mental health intervention in the form of:

Planned prevention

Facilitated discharge from hospital

Step towards independent living

Maintenance

Crisis/emergency response
Through the evaluation we heard about Shared Lives being used to support people with
mental ill health in all of these ways and examples are included in later sections of this
report showing the positive outcomes for people. The exception to this is the case of Shared
Lives as a response to crisis. Although there were a small number of examples where this
has happened, schemes have not generally planned to offer this sort of support and the
cases were usually in response to specific requests and agreed on a case by case basis. It
was generally acknowledged that being able to respond as quickly as a crisis intervention
requires is not a good fit with the careful matching process that is a crucial part of the
Shared Lives model. There was also wariness around the risks associated with placing
someone in a household for the first time at a point of crisis without the time usually taken
to collect full information, complete detailed assessments and form a relationship. This does
not necessarily mean that Shared Lives is not suited to this sort of provision but schemes
20
wanting to provide crisis/emergency support may need to make some significant changes to
processes and procedures and to the support offered to Shared Lives carers providing
support in these contexts.
The people who have been supported in Shared Lives arrangements through this project
have had a range of diagnosed mental health conditions including bipolar disorder,
schizophrenia, obsessive-compulsive disorder, personality disorder, depression and anxiety.
Because most people were eligible for health or social care funding (we did not come across
anyone self-funding through the evaluation although it is identified as an option), they
tended to have diagnosis of a serious mental illness and were receiving secondary care
services.
In terms of referral routes, the schemes can essentially be divided into two categories:

Those that receive referrals from mental health teams

Those that can receive referrals from any source including health professionals,
voluntary sector organisations and self and family referrals
This broadly reflects whether the schemes are in-house local authority schemes or
independent providers, with independent providers having more flexibility to receive
referrals from any route. Some of these potential sources of referrals – such as voluntary
sector organisations – have not yet been used.
Closely linked to the referral system and diversity of referral routes are the mechanisms by
which Shared Lives arrangements for people with mental ill health are funded. Day support
and short breaks are usually a set cost per session or per night and are funded by social
care, health, self-funding or a combination. Long-term Shared Lives arrangements are
usually funded by three sources:

A care and support payment which is paid by social care, health or someone selffunding their care/support. The care and support payment usually covers support
in the evenings, weekends and first thing in the morning.

A payment for accommodation provided (the room the person using Shared Lives
rents from the Shared Lives carer). This is usually paid for by housing benefit (if the
person is eligible).

A contribution from the person living in the Shared Lives arrangement towards
board and lodgings (often known as the service user contribution), this is to
contribute to the cost of bills and food
21
The evaluation identified a range of mechanisms that have, or could have been used to fund
Shared Lives arrangements for people with mental ill health:

Block contracts

Council managed personal budgets

Direct payments

Direct payments via independent brokerage

Section 117 aftercare on discharge from section

Personal Health Budgets

Self-funders
As with referral routes, some of these are identified funding sources or mechanisms that
could be used and have not yet been. Schemes differed in their readiness or ability to work
with these mechanisms (as discussed in more detail below) again depending on whether
they are in-house local authority or independent, and some mechanisms are more
commonly used than others.
The purpose of this section has been to describe the different ways Shared Lives has been
used to support people with mental ill health and to emphasise the variability. There is no
one single model that works as a mental health support – different combinations of
arrangement types can work to support people at different stages of their recovery and this
can change over time as the person’s needs change. This flexibility means that Shared Lives
is able to provide an individualised person-centred form of support for people with mental
ill health.
Recommendation for Shared Lives schemes: Be prepared to be flexible. Offering flexibility
in the ways that Shared Lives can be delivered (by arrangement type, referral route and
funding accepted) will both maximise the opportunities for Shared Lives as an option and
offer more personal individualised support.
22
5. Progress towards outcomes
This section describes the progress towards the five outcomes for the project that were
developed as part of the Theory of Change workshop. The five outcomes cover outcomes
for individuals, outcomes for schemes and outcomes for the mental health sector. The
discussion of the progress towards outcomes follows a logical order: firstly exploring the
extent to which Shared Lives has become known and recognised as an option in the mental
health sector; secondly exploring how and whether this has led to an increase in the use of
Shared Lives for people with mental ill health; thirdly looking at the impact of being in a
Shared Lives arrangement for people with mental ill health; and fourthly looking at progress
towards Shared Lives becoming part of the landscape of mental health support and
provision. Finally, cutting across the other four outcomes we consider the skills, knowledge
acquired and contributions made by people accessing, experiencing and delivering Shared
Lives.
OUTCOME: Increased understanding of Shared Lives as a viable option for people with
mental ill health in the mental health sector
Including:
a)
organisations working with people with mental ill health; and
b)
better relationships/partnerships with people and organisations working with
people with mental ill health
While Shared Lives is established and well known among people and organisations working
with people with learning disabilities, the same cannot currently be said for people and
organisations working with people with mental ill health. This was well recognised by the
schemes, and increasing the awareness and understanding of Shared Lives in the mental
health sector was a key focus for their activity throughout the project.
Under the project, all schemes have undertaken awareness raising activities in order to
promote Shared Lives to professionals and organisations who support people with mental ill
health (who will potentially refer to Shared Lives). Schemes used a range of methods to do
this including securing invitations to mental health team meetings, meeting with individual
commissioners and mental health team leads, putting on events and visiting voluntary
sector organisations and user groups. Two schemes have offered and provided inductions or
training for newly qualified social workers so that they are aware of Shared Lives as an
option from the start of their careers.
23
A number of the schemes reported frustrations in trying to make in-roads into contact with
mental health teams:
“The biggest battle has been to break into the mental health team itself, people are
not responding to contact” Shared Lives lead
Schemes are maximising existing relationships and ‘ways in’, for example through former
colleagues and success has often hinged on a pre-existing relationship with an individual in a
relevant team or position. For those that don’t have these links it is a bigger challenge to
start from scratch. In terms of gaining access to mental health teams, local authority
schemes appear to have an advantage over independent schemes. This was most strongly
the case in areas where there were greater levels of integration between health and social
care, for example where mental health teams are located in the same building as the Shared
Lives scheme, or where they share communication systems.
Building awareness through these approaches is often a slow process and in a short-term
project the schemes may not have yet had the time to see the fruits of their efforts. While
some of them felt they had made a lot of effort for limited results, one scheme where the
lead described talking to anyone who would listen, feels this approach has been key:
“Getting relationships established is vital. Once people understand what it’s about it
opens things up” Shared Lives Lead
Despite some of the frustrations voiced by schemes that they had not got as far as they
would have liked in increasing levels of awareness among mental health professionals and
practitioners, interviews across the schemes demonstrated that they have all made progress
in this area. Where mental health professionals have become aware of what Shared Lives
can offer, it was often met with significant enthusiasm:
“Shared Lives is a wonderful, wonderful idea… Institutions deskill and dehumanise.
They keep people safe but no other aspect of their lives is considered, the person
doesn’t have a life… Shared Lives is a great way of achieving positive outcomes away
from institutions...” Service Manager, Mental Health team
“I think it’s an ideal way to support people… it’s so much better than other respite
options.” Community Mental Health Matron
“In some respects Shared Lives is an ideal solution for a lot of people… The case I’ve
had has opened me up to it as an option.” Mental Health Specialist Accommodation team
This last statement is key – having seen what Shared Lives can offer, this mental health
professional was “converted” to the concept of Shared Lives. In the very vast majority of
cases it was as a result of seeing a case that convinced people that Shared Lives is a good
option for people with mental ill health, rather than as a result of the networking and
24
promotional activity that the schemes had attempted. A health professional at a hospital
where a patient had moved on to a long-term Shared Lives placement, had never heard of
Shared Lives before. Having observed the application process and seeing how the patient
had settled in with his Shared Lives carer, she commented:
“What an absolutely marvellous thing. One of the best things I’ve ever seen!” Health
professional
For these professionals, it has been seeing the positive impact it has on their patients or
clients that has convinced them. These enthusiastic people have become ‘champions’ for
Shared Lives, telling colleagues about it and recommending Shared Lives as an option. This
demonstrates how important it is for people to “see” how Shared Lives can work for people
rather than just hear about it. It is not simply a matter of getting mental health professionals
to be aware of it as an option, but to consider it.
“For social workers the idea of living in someone’s home is a strange concept – they’re
not thinking about it, it’s not on their radar. Professionals need to build their
confidence in it.” Manager, Mental Health Trust
Interviews with mental health professionals who have experience of referring to Shared
Lives reveal that Shared Lives schemes are well regarded and there are high levels of trust.
However, this trust and confidence needs to be built through experience and this will take
time.
Although it may feel to schemes that progress is slow in this area, there are definite signs
that awareness of Shared Lives for people with mental ill health is expanding. Schemes
looking to develop Shared Lives as an option for people with mental health should
acknowledge that this is not going to happen overnight and that the best way of spreading
the word is through providing really good support and getting this known about.
Recommendation for Shared Lives schemes: Make the best out of existing links - identify
existing links that people within the Shared Lives team have with mental health teams or
people in strategic roles and start with these.
Recommendation for Shared Lives Plus: Develop guidance or provide support to help
Shared Lives schemes understand the structure of mental health services and who to liaise
with or target.
Recommendation for Shared Lives schemes: Identify Shared Lives champions - harness the
enthusiasm of mental health professionals who have seen the outcomes of Shared Lives and
encourage them to be an ambassador or champion for Shared Lives within their teams and
organisations.
25
Recommendation for Shared Lives schemes: Make use of case studies – when you have a
good story, tell it! Stories help people to visualise what Shared Lives can offer better than a
description of the model. Think about different ways of sharing stories – for example on
your website or through short films.
Recommendation for Shared Lives Plus: Develop a section of the Shared Lives Plus website
dedicated to mental health – tell stories through case studies or short films.
OUTCOME: Increased capacity within the Shared Lives sector to support people with
mental ill health
c)
The target for the project was that the schemes would grow their mental health support by
100 arrangements across the seven schemes, which will be a combination of day, short
break and long-term arrangements. Project monitoring data provided in monthly reports to
Shared Lives Plus shows that by the end of September (Quarter 3) there were a total of 71
new arrangements across the seven schemes - 16 day arrangements, 30 short breaks, 21
long term and 4 that were not specified (likely to be a combination of support). Given that
momentum appears to be increasing as the project has progressed it seems likely that the
target will be met by the end of December 2016.
Figure 2: Number of new Shared Lives arrangements
Number of new Shared Lives arrangements for people
with mental ill health across the seven project schemes,
January to September 2016
Unspecified
4
Day support
16
Long term
21
Short breaks
30
While all schemes have made progress towards increasing the number of people in Shared
Lives arrangements, in terms of generating new referrals, the experience of the Shared Lives
schemes was varied. In some schemes referrals have been higher than anticipated, and in
26
two cases the steady flow of regular referrals has led to the recent or imminent recruitment
of a new team member in order to manage demand.
Where volume of referrals has exceeded expectations, there have been a number of factors.
The schemes that have generated more referrals than they had initially anticipated are
those who, either through design or opportunity, are in a position where Shared Lives can
routinely be put forward as an option when support packages are considered. For example,
in two schemes a member of the Shared Lives scheme staff attends weekly or fortnightly
mental health panel meetings where support packages for individuals are discussed. Having
this presence means that the Shared Lives staff member is able to identify where Shared
Lives would be an appropriate option for an individual. This is working well both in
generating new referrals and raising the profile of Shared Lives among mental health teams.
In another scheme there is an integrated brokerage process that all social care packages go
through whether they are learning disabilities or mental health, and in this area the local
authority has directed that Shared Lives should be considered for all options. Becoming part
of the process in these ways creates regular opportunities for Shared Lives to be considered.
It seems that local authority schemes are more likely to have these opportunities to become
integrated into processes than independent schemes.
Another factor is where schemes have been able to seize opportunities (or respond to
demand) as a result of local gaps in services or provision. In one scheme, where Shared Lives
is being used primarily for long-term arrangements, an increase in referrals has been part of
a drive to move people with mental ill health out of residential care. In two of the schemes,
use of Shared Lives for short breaks is progressing well as a result of there being limited
alternative options for respite.
As a personalised form of support, Shared Lives seems to be growing more quickly in areas
that place high priority on person-centred approaches:
“We’re very focused on the personalised care agenda… you would have to have a very
good reason for someone to go into residential care… We’re trying to develop a
continuum of services with things like local area co-ordination and Shared Lives” Head
of Service for Mental Health teams
It seems that Shared Lives is more likely to flourish in areas where there is a strong ethos of
personalisation.
While all of the schemes have generated new referrals, some have reported difficulties with
reaching the targets specified for the project. A number of particular challenges have been
identified.
27
For schemes that have not had the opportunity to become integrated into the process of
agreeing support packages such as attending panel meetings, there is a sense of having to
work hard for each referral by putting a great deal of work into increasing the knowledge of
individual mental health professionals and promoting Shared Lives as described above. One
scheme has worked hard on promoting Shared Lives through trying to meet with mental
health teams and mental health organisations but found that referrals were slow. Having
now had the opportunity to meet with the head of commissioning for mental health who is
considering commissioning Shared Lives specifically for enablement, the Shared lives staff
have recognised the importance of this:
“Until we get commissioners on board, there’s nowhere we can go. If this doesn’t
happen, we’ll just be chipping away at it slowly.” Shared Lives staff
For Shared Lives to expand more than one case at a time, there needs to be ‘buy-in’ from
those with strategic or commissioning responsibilities. However, the experience of one
scheme shows that this on its own is not enough. In this area, although interest in
developing Shared Lives for people with mental ill health was initiated by the Mental Health
Trust and preceded the project, referrals were slow:
“the [Service Manager] is behind it, the Mental Health Trust is behind it, the problem is
translating this into actual referrals.” Mental Health Trust
This scheme had found that despite ‘buy-in’ from the right people within the Mental Health
Trust, work still needed to be done with social workers and mental health practitioners to
generate referrals.
Another set of challenges are those arising from local authority and/or health processes (or
the interface between the two). One scheme reported the challenge of a backlog in the
referral system as their social work team is short of capacity to undertake the necessary
assessments. The system ensures that people referred to Shared Lives are eligible for social
care and hence will receive adequate funds, but can also create significant delays in
beginning the matching process. In another scheme, where the team are able to handle
direct referrals from any source, staff also described difficulties around delays in funding
allocation, and referenced past experiences where Shared Lives arrangements have fallen
through where adequate funds had not been allocated. In one local authority scheme, for
the mental health team to make a referral to Shared Lives, a mental health professional has
to go through the general public council telephone number, often with long waits of up to
20 minutes. This has the result of deterring referrals from busy professionals. In some cases
incompatible IT systems make referrals more complicated than needed.
Funding mechanisms in theory can offer an opportunity, but were more often a barrier. As
described above, there are a range of ways that Shared Lives arrangements can be and are
28
funded. Whether the funding mechanism is an enabler or a barrier depends on a number of
variables, including whether the scheme is in-house local authority or independent, and the
extent to which personal budgets and direct payments are used in the area. One scheme
attributed the recent increase in the use of day support to the growth of personal budgets
for people with mental ill-health. Recognising this as an opportunity, they had actively
sought to increase this type of referral, yet this requires good working knowledge of
personal budgets and brokerage services and the local systems of administration. Some
local authority schemes are under a block contract with social care, some specifically for
learning disabilities, and receiving other forms of funding is either not possible or is difficult.
There were varied experiences across the seven areas in terms of how the local authority
has implemented the use of personal budgets - with some being predominantly council
managed and one area having high use of direct payments. The local authority schemes
were not able to accept direct payments or self-funding. While schemes that are part of the
local authority may enjoy benefits of easier access to becoming part of the process,
independent schemes tend to be more flexible in the kind of funding they can receive.
“The funding is not straightforward – it would be more straightforward if we were
independent”. Shared Lives lead
The generation of referrals depends on the right combination of type of organisation and
type of funding mechanism - the funding mechanism needs to fit with the structure and
processes of the scheme.
These insights demonstrate that there is no straightforward one-size-fits-all route to
successfully generating new referrals. There is a huge variety of factors even across just
seven areas: whether the scheme is council or independent; the level of integration
between health and social care; the structures and processes used to decide on support
packages; the extent of the use of personal budgets and direct payments; all have an impact
on generating referrals and all have the potential to enable or be barrier.
Recommendation for Shared Lives schemes: Become part of the process – understand your
local commissioning procedures, identify the key mechanisms (e.g. panel, brokerage,
preferred provider lists) and focus on ensuring that the scheme fits with the process.
Recommendation for Shared Lives schemes: Identify decision makers – if referrals have to
come through a care manager, focus attention on promoting Shared Lives to social workers
and mental health teams; in areas of high levels of use of direct payments, focus attention
on promoting Shared Lives to individuals and their families.
Recommendation for Shared Lives Plus: Develop guidance or provide support for Shared
Lives schemes to better understand commissioning and funding processes.
29
d)
More Shared Lives carers
The target for the project was to increase the number of Shared Lives carers offering mental
health support by 31 across the seven project schemes. At the first reporting month for the
project (February 2016) the schemes reported 71 Shared Lives carers offering mental health
support. This steadily increased to 87 at the end of Quarter 1, 105 at the end of Quarter 2
and 112 carers at the end of Quarter 3. The project has therefore met its target in terms of
increasing the numbers of Shared Lives carers offering mental health support.
Figure 3: Number of Shared Lives carers offering mental health support
Number of Shared Lives carers offering mental
health support
120
105
100
80
112
87
71
60
40
20
0
February
March
June
July
All schemes reported that the increase came from both existing Shared Lives carers who had
been supporting people with other primary support needs, and from new Shared Lives
carers recruited specifically to support people with mental ill health. Most of the schemes
let their existing Shared Lives carers know about the project, and some targeted those who
they knew had a background or some experience of working with people with mental ill
health. New Shared Lives carers going through the usual recruitment processes are given
the option to say whether they would support people with mental ill health, learning
disabilities, people with dementia etc. (depending on what each scheme offered).
The evaluation identified a variety of methods employed by schemes to recruit new Shared
Lives carers, including traditional marketing methods such as leaflets and newspaper
adverts to reach potential new Shared Lives carers in the local community. One of the
schemes specifically targeted a recruitment advert at attracting people to provide support
to people with mental ill health but found this attracted very few enquiries relative to the
cost of advertising. Some methods were dependent on the location of the team. For
example, one scheme was able to place advertisements for Shared Lives in the payslips of
care staff employed by the Council, which was thought to provide a useful and cost-effective
means of reaching a highly relevant audience. One scheme mentioned that this would be an
30
effective approach but they do not have access to it since they are located outside of the
local authority. Schemes also commented that most new Shared Lives carers come to learn
of the scheme through word of mouth. This is perhaps unsurprising given the significance of
an endorsement from a well-known and trusted source, who can share detailed insights of
their personal experience.
The schemes had attracted a number of new or existing Shared Lives carers with significant
past experience of working in mental health. These included someone with experience of
working in a psychiatric ward, a mental health nurse, a mental health lecturer and people
with related experience such a nursing and foster care. There were mixed views about
whether experience of mental ill health, either through past employment or through
personal experience was needed to offer support for people with mental ill health.
“We don’t get people who are just a bit depressed – they won’t be eligible. It’s more
acute, people are likely to have been hospitalised, have a label of schizophrenia,
bipolar, early onset dementia – I think carers need to have had some experience of
mental ill health to be able to deal with this.” Shared Lives staff
On the other hand, a new Shared Lives carer whose first long term arrangement was
someone with depression, anxiety and autism who had no experience with either mental
health or learning disabilities felt that the training she received as part of the application
and induction process prepared her well, and the placement had gone smoothly.
Another area which attracted mixed views around Shared Lives carer recruitment was the
extent to which the stigma surrounding mental health deters carers from supporting people
with mental ill health.
“I would have said no this isn’t an issue until our recent recruitment drive… when we
mention mental health people are wary… people’s perceptions are definitely a barrier.
More people want to support people with learning disabilities” Shared Lives lead
As part of the fieldwork in one scheme we had the opportunity to meet around 20 existing
Shared Lives carers as part of their quarterly meeting, most of whom had been Shared Lives
carers for some time with people whose primary support needs were learning disabilities.
They were asked about general feelings towards supporting someone with mental ill health.
There was a general sense of caution. Some who had grandchildren at their homes said they
would be more wary of supporting someone with mental ill heath in their home than
someone with learning disabilities. The scheme lead later told us that several of these same
Shared Lives carers currently support people who have quite significant mental health
problems alongside a learning disability:
31
“The carers say “we wouldn’t touch mental health” – but they’re already doing it! Lots
of the people with learning disabilities that they support also have mental health
issues. They see the person they care for as individuals, they don’t see their mental
health problems.” Shared Lives lead
It seems that while the label might deter Shared Lives carers, faced with an individual with a
set of needs, they are more likely to see beyond the diagnosis.
“People are carers because they care, they need to see the individual not the label”
Shared Lives scheme lead
Recommendation for Shared Lives schemes: Support Shared Lives carers to see people as
individuals rather than the mental health diagnosis they may have - provide them with
sufficient information about the individual so they can see past the label to the person.
Recommendation for Shared Lives schemes: Continue to raise awareness about mental
health through educating and training Shared Lives carers. Make use of the Shared Lives
Plus training pack for Shared Lives carers.
Recommendation for Shared Lives Plus: Promote and distribute the Shared Lives Plus
training pack for Shared Lives carers.
e)
Well supported Shared Lives carers
The assessment, training and induction of Shared Lives carers follows similar structures in
each scheme, including a series of checks, references and visits, training sessions over a
number of weeks and approval via an independent panel. All of the Shared Lives carers
interviewed spoke positively about the process, understanding the need for the detailed
assessment and feeling prepared for the role.
One issue raised by some new Shared Lives carers was the wait between being approved
and getting their first ‘match’. One person had left her job to become a Shared Lives carer
and initially felt frustrated that there wasn’t someone ready waiting for her. As one Shared
Lives staff member described it:
“It’s a bit chicken and egg with recruiting Shared Lives carers with mental health
experience – if we have a Shared Lives carer and then can’t place someone for a while
they get frustrated.” Shared Lives staff
This is an almost inevitable challenge for a model which places so much emphasis on getting
the match right. This is not unique to mental ill health, and is identified as a challenge for
the Shared Lives model in general.
32
Shared Lives carers were happy with the level of ongoing training and support. They talked
of training, some of it optional, some that all Shared Lives carers were expected to attend,
including on subjects such as deprivation of liberty safeguards, mental capacity,
safeguarding, medication and first aid. The schemes all had regular carers meetings, some
had additional get-togethers without Shared Lives staff, and some schemes put on social
events for Shared Lives carers to attend with the people they were caring for.
Shared Lives carers usually have an identified support officer or similar who supports them.
The Shared Lives carers interviewed spoke highly of the support they received from Shared
Lives staff:
“The Shared Lives team are absolutely fantastic – if they weren’t it would be different.
It’s a good service and it’s well run.” Shared Lives carer
In particular, they spoke of there being support for them when they needed it:
“Support from [the scheme] has been brilliant. If my support officer is not there
someone else will help.” Shared Lives carer
“I’m very happy with the process, and [name of Shared Lives staff] is an absolutely
tremendous support for me. If I’ve got any queries I know that she will follow that up.”
Shared Lives carer
“[the scheme] are open to any communication from us. If we think there’s an issue we
just get in contact. If there’s something we think needs addressing, if they can deal
with it they do, if they need to go higher up the chain then they do.” Shared Lives carer
“I think that because the communication is so good with Shared Lives, you don’t feel as
though you’re on your own. I know for a fact that I can ring this office, and there will
be someone to help straight away. I don’t know of any other service that I could
compare it with.” Shared Lives carer
“I think they’ve got it right. I don’t need more calls, I know if I need help I can call
them”. Shared Lives carer
An area where this could be challenged is if the impact of continued funding pressure means
a reduction in size of the Shared Lives staff team. In one scheme, as a direct result of having
to reduce the staff team, meetings with Shared Lives carers were reduced from once a
month to once every two months and there were some early signs that this was being felt
by Shared Lives carers. Although this only came up in one scheme, with the ongoing funding
pressures there is the possibility that this could be experienced more widely.
The main issue that the Shared Lives carers identified as problematic was when they did not
receive sufficient information about the person placed with them:
33
“One of my young men is very complex, he can refuse to leave the house even though
it was agreed he’d be out of the house every day, his needs are much greater than the
social worker told us…. the information from the social worker was lacking so the
package I was offered is not what I’ve got.” Shared Lives carer
Similar issues were raised a number of times by Shared Lives carers, though in all cases they
recognised it was because the mental health professionals had not shared important
information, rather than the Shared Lives staff. It was not clear whether mental health
professionals felt Shared Lives carers and staff didn’t need to know, or whether there was
an element of deliberate withholding in order to secure a placement for their client. The
importance of Shared Lives carers receiving full information should not be underestimated –
this was the single biggest criticism identified by Shared Lives carers across the schemes.
In terms of the impact that being a Shared Lives carer has on their own lives, overall there
was great enthusiasm about their roles.
“It’s enhanced my life, they’re part of my family, it’s an absolute pleasure.” Shared Lives
carer
Several Shared Lives carers stressed the impact it has on their own wellbeing and happiness.
Two Shared Lives carers emphasise how happy the role makes them compared to other jobs
they’ve had:
“I’m happier… At my last job I used to dread going home from holidays. Now I look
forward to seeing [people she supports] again.” Shared Lives carer
“It’s been good for me too. It gives me a balance. I won’t work full time for [company
name] again… I have fun with these [people she cares for], they know I like a laugh and
a joke.” Shared Lives carer
Another Shared Lives carer talked of the freedom she feels she has compared to a
conventional job being able to have the freedom to do her own thing and pursue hobbies
when the people she cares for are out during the day.
Shared Lives carers are paid an allowance but it is not the equivalent of a wage. Interestingly
low “pay” was primarily raised as an issue by the staff rather than the Shared Lives carers
we spoke to. As one Shared Lives carer highlighted, although the amount she got for
providing day support was low, she used to do a similar activity voluntarily. Shared Lives
carers tended to stress that it’s not about the money:
“People close to us think we must get paid a lot to do this. But we don’t, cleaners are
paid more. But we don’t do it for that.” Shared Lives carer
“I do it for the love, not the money” Shared Lives carer
34
Rather than the money, Shared Lives carers are motivated by the reward they get from
seeing improvements in the lives of the people they care for:
“When we know them, we know when they are doing well and that is priceless. We
look at how he is now, and how he was at the start and that is the main reward for
us.” Shared Lives carer
“I look and I think, that’s the fruit of my hard work, the progress that they make.”
Shared Lives carer
“What you put in you get out… Me supporting [person’s name] and him having a good
life is great. It’s rewarding.” Shared Lives carer
This enjoyment and reward that Shared Lives carers experience frequently leads them to
recommending it to friends and family – an important source of recruitment as highlighted
above.
“I’m a poster girl for Shared Lives! It’s a great job.” Shared Lives carer
Recommendation for Shared Lives schemes: Ensure adequate support is provided to
Shared Lives carers – where resources (financial and staffing) are stretched, explore
different ways of providing support e.g. conference calls, webinar training/support, online
support.
OUTCOME: Individuals with mental ill health have better choice and control over their
lives and their support, and improved mental health and wellbeing
The underlying rationale for this project and for aiming to extend Shared Lives for people
with mental ill health is that it is a form of support that will deliver better outcomes for the
individuals supported. This outcome, therefore is particularly important.
a)
Individuals have better choice and control over their lives and their support
Choice and control can be considered in a number of areas; choice and control over the
support option, choice and control over elements of the support, and choice and control
over activities and day to day living enabled through being in a Shared Lives arrangement.
A number of examples emphasise the choice that individuals had in deciding whether
Shared Lives was the right option for the support they needed. One particularly vulnerable
man was not able to return to his family home after a spell in hospital and a long-term
Shared Lives arrangement was suggested to him as an option. A healthcare professional
working at the hospital described the level of care the Shared Lives staff took to ensure he
understood the option and that he knew he had a choice. He was visited by a Shared Lives
staff member who described Shared Lives and gave him time to think about it to see if felt
right for him. He was then visited in hospital by the Shared Lives carer they had identified
35
for him and again given time to think about it. This was followed by a visit to the Shared
Lives carer’s house for tea. Although the individual was clearly enthusiastic about both the
thought of Shared Lives and the carer he was introduced to, the healthcare professional
described how impressed she was at how they made it clear at each stage that it was his
decision.
In another case, Shared Lives was being considered for respite for a woman as an alternative
to a residential respite which she hadn’t liked. The mother of the woman describes how
they both met the Shared Lives family to see what her daughter thought of the idea. After
meeting the family her daughter was happy about the arrangement.
“I just felt it would be alright. I knew that she wouldn’t say she wanted to go if she
doesn’t want to.” Mother of person in Shared Lives arrangement
This choice at the stage of agreeing a placement seems to be well embedded within the
Shared Lives model.
Although there was a choice of whether to be in the arrangement or to choose another
support option, there was limited evidence of individuals having a choice over the Shared
Lives carer or placement. The careful matching process conducted by Shared Lives teams,
takes into account the individual needs and preferences of the person, including
geographical location, but we only came across one example of individuals being able to
choose their carer. One of the schemes highlighted that they would like to do this but it
simply wasn’t possible with the number of Shared Lives carers they have available –
sometimes it can be difficult to find a suitable match, let alone to be able to offer a choice of
Shared Lives carers. Although this is something some schemes may aspire to, in reality it is
very difficult for schemes to be in the position of having enough Shared Lives carers with
vacancies to be able to offer this.
Part of the rationale behind why Shared Lives is seen as a positive alternative to more
traditional forms of care and support is that people are living in communities, among
families and that this gives them the opportunity to pursue their own interests in a way that
they may not have the opportunity to do in more traditional settings. There were many
examples of this. One young woman who receives day support started to write some music
in response to a bereavement she had experienced. As the Shared Lives carer’s son
produces music as a hobby, they are working together to make her music into a CD. Another
Shared Lives carer works part time in their local pub so has introduced the two men she
cares for to the locals in the pub who they now play pool with. Others who enjoy gardening
or baking have been matched with Shared Lives carers who like to do similar things. One
man in a long term arrangement talked about his bedroom which is full of Star Wars
paraphernalia – something he had not been able to do where he previously lived. People
have been able to share family holidays with their Shared Lives carers. One Shared Lives
36
carer who has been supporting two men with mental ill health in long-term arrangements
which pre-date this project told us about a trip the three of them had taken to take aid to
the refugee camp in Calais. One man told us about how the thing he had wanted most when
he came to live in his Shared Lives arrangement was to own a motorcycle. His Shared Lives
carer supported him to save up for one, he has now bought it and this has given him the
freedom to be more independent and to visit his family and improve relationships with
them.
The individual’s right to choice and control does not always work perfectly from the point of
view of Shared Lives carers – one described how she was looking forward to sharing her
hobbies of camping, sailing and walking with the young man she cares for but all he is
interested in is watching TV. On one hand, this was his choice and it is important that he is
able to make it. On the other hand, this example demonstrates that there needs to be
careful balance between choice for the individual and the key principle of Shared Lives that
the supported person is fully involved in the life of the Shared Lives carer and their family,
which can include providing motivation for the person to pursue activities.
One scheme actively engages advocates to work with individuals when they need to make
important decisions including where they may conflict with the interests of Shared Lives
carers – for example for one person who felt it was time to move on and wanted to leave
the arrangement, and for another person who was unsure whether to continue attending a
day centre.
One area where an individual’s choice may be constrained is the expectation in some longterm placements that the person is out of the house during week days. One young man who
went to college felt unhappy that during the college holidays the Shared Lives scheme had
made it clear he was expected to stay out of the house. Although he was extremely positive
about his placement and his Shared Lives carer, this aspect made it felt less like it was his
home. It is our understanding that this is in the interest of carers as they are not expected to
provide care and support for 24 hours a day, but can have the result of restricting people in
their choices of what to do during the day.
Recommendation for Shared Lives Schemes: Where possible and appropriate provide
people entering into Shared Lives arrangements a choice over their Shared Lives carer.
Recommendation for Shared Lives Schemes: Ensure that Shared Lives carers and staff are
aware of all the local options available to people with mental health needs e.g. peer support
groups, recovery colleges, drop-in centres etc., as well as other non-mental health activities
to ensure people in Shared Lives arrangements have full choice.
Recommendation for Shared Lives Schemes: Encourage the use of independent advocacy
to support choice around important decisions.
37
Recommendations for Shared Lives Plus: Promote the use of independent advocacy to
Shared Lives schemes.
Individuals with mental ill health have improved mental health and wellbeing
It was initially envisaged that the My Shared Lives outcome tool would provide the primary
source of data to measure this outcome. As the evaluation has progressed it has become
clear that it is the qualitative accounts – the observations of Shared Lives carers and mental
health practitioners, the stories of people in Shared Lives arrangements, and the case
studies provided by schemes - which provide a rich insight into the impact that Shared Lives
can have on the lives of people with mental ill health.
In terms of the impact on general wellbeing, Shared Lives carers are in a good position to
observe changes in the person they care for and there were consistent observations about
the improvements:
“He has put on weight, he’s wearing new clean clothes, he’s in a good routine. He used
to just watch TV, now he’s out doing something every day” Shared Lives carer
“She is doing well, she is very careful with her money. She controls her finance. She
does her own shopping. She eats well. She wasn’t eating much before, when she was
staying with her family.” Shared Lives carer
“He seems more relaxed, looks healthy, has been eating healthier with us and has lost
some weight.” Shared Lives carer
Individual stories are the best illustration of the impact that Shared Lives can have on
people’s mental health and wellbeing. Through the evaluation we heard many examples and
stories. The examples selected here show a range of different ways that Shared Lives
arrangements have benefited the lives of individuals.
Ryan’s case shows how a long-term live-in arrangement provided him with the stable and
supportive environment to focus on his college work and prepare him for independent
living.
Ryan, 20, has depression, anxiety and Asperger’s. Earlier this year his relationship with his
family broke down and he found himself in a homeless hostel.
Ryan was told about Shared Lives while he was in the hostel “There were other options
but I was too nervous to do those. I wasn’t ready to live on my own, at that time I wanted
more support, I had depression, I didn’t want to be on my own”.
He liked the idea of Shared Lives and was matched with a couple, Alison and Terry. He
visited them for tea, then stayed a night and moved in 3 days later. He was initially
38
apprehensive as he had moved a lot, and people he’d trusted had turned their back on
him, but he very quickly felt he could trust Alison and Terry.
Ryan feels very at home and settled with Alison and Terry. He has meals with them and
spends time with their extended family who come round. He thinks of Alison and Terry a
bit like adoptive parents and likes the fact that they’re there for him, checking he’s eating
well and taking his medication “I quite like having someone looking out for me… there’s
someone there if I need it”.
Ryan goes to college and works part-time. Having the stability of living with Alison and
Terry has meant he can focus on these instead of worrying about his situation “A lot of
worries have gone away, I could get back to thinking about college instead of worrying.”
Having lived with Alison and Terry for 6 months he is now starting to think about living
independently “Six months living with a family has prepared me for the real world, I
wasn’t ready to live on my own six months ago, I’d have ended up in debt, homeless,
mental health breakdown. It’s a good stepping stone.”
He thinks he will miss Alison and Terry and they’ll miss him but he knows they will keep in
touch.
Elizabeth’s case provides an example of how a planned short break arrangement has
prevented a mental health crisis and hospital stay.
Elizabeth, 58, has a mild learning disability and long history of mental ill health with a
diagnosis of personality disorder. Elizabeth lives on her own with a substantial support
package to help her to live in the community. She has a long history of verbal and physical
aggression towards professionals and support workers and had recently physically
assaulted the manager of one of the teams who supports her, resulting in that provider
withdrawing.
Elizabeth usually goes into crisis a couple of days before the anniversary of the deaths of
significant people in her life – her family members and best friend – and is usually
hospitalised for up to four weeks at a time. Elizabeth was referred to Shared Lives by her
care co-ordinator who felt she would benefit from respite around the time of these
difficult anniversaries.
Elizabeth was able to be matched with two carers who knew her from having supported
her in residential services when she was younger. The plan was for Elizabeth to go and
stay with the carers two days before a significant anniversary to try and avoid a crisis and
significant deterioration in her mental health.
39
Shared Lives collected the relevant information together ensuring care plans, assessments
and crisis plans were all in place. After discussions with Elizabeth to ensure she was happy
to go ahead with the placement, she had a tea visit and a day visit before her first threenight break before the anniversary of her friend’s death. The carers ensured that they
spent lots of time with Elizabeth, listened to her advice about when she needed to be on
her own and talked with her about her friend when she wanted to. Although it was an
intense few days, the visit was very successful from the points of view of all parties. The
care co-ordinator said that this was the first time in five years that Elizabeth was not
admitted to hospital around the time of this particular anniversary. Elizabeth said she had
felt safe at the carers house and that she knew there was someone there who cared
about her. The next visit is currently being planned.
Becky’s story illustrates how Shared Lives day support is supporting her to maintain
independent living and prevent hospitalisation.
Becky, 20, has been diagnosed with unstable personality disorder and Asperger’s. She has
a history of self-harming and has attempted suicide in the past. She has been supported
by the mental health team for some time and has had several admissions to hospital.
Becky moved into her own flat around 14 months ago but has spent very little time living
independently due to being readmitted to hospital several times. This put her tenancy at
risk. Becky was referred for Shared Lives day support and was introduced to a Shared
Lives carer while she was still in hospital with a view to her having support when back at
home. Becky was initially hesitant but when she realised the carer had similar interests,
such as a love of dogs and being outdoors, she began to engage.
Annie, the Shared Lives carer, has been supporting Becky for two days per week for a few
weeks now. The support has encouraged Becky to engage in other support being provided
by housing. Becky is a very quiet and shy individual but, due to the Shared Lives Annie’s
sensitive approach, she has opened up to her and they are developing a supportive
relationship.
This has been the longest Becky has lived independently without being readmitted to
hospital. She is feeling positive about the future at present and is exploring further
education and voluntary work with the support of Annie.
Due to the short timescale of the project the people who have entered arrangements as
part of the project have had relatively short periods in Shared Lives arrangements. The case
studies below – Jeremy and Tamsin – are examples from some of the schemes who had
40
supported a number of people with mental ill health before the project. Jeremy’s story
shows how Shared Lives support has been able to change from supporting him in a longterm arrangement to supporting him through respite to support him living independently.
Tamsin’s case shows how support in long-term arrangement has given her stability and
significantly reduced the support she needs from the mental health team.
Jeremy, 48 years old, has been supported by Shared Lives since 2013. He had previously
been married, owed his own home and had a full time job. Following the break-up of his
marriage he was admitted to hospital under the Mental Health Act and was re-admitted
several times over a number of years. Following his last hospital admission, he was
discharged to supported accommodation for a fixed period of 2 years. During this time, he
experienced fluctuations in his mental health, leading to dependency on alcohol, and did
not find the support from the scheme consistent.
As the supported accommodation period came to an end, the mental health team
approached Shared Lives to look at the possibility of accommodation and he was placed
in a live-in arrangement with Tony. After meeting with two carers and their families,
Jeremy decided that he would prefer to live in Tony’s household, feeling that he had more
in common with him.
A period of adjustment followed, with initial difficulties throughout the first six months.
Tony was already supporting two other people through Shared Lives, and Jeremy found it
difficult to form a relationship with one of them and tensions would rise. Over time, the
two men have developed a strong friendship.
Jeremy has found that support has been there when he has needed it. He has been able
to talk to Tony about his anxieties and has slowly worked on reducing his alcohol intake.
Tony has worked alongside Jeremy to alleviate anxieties around going out in the
community and has helped him to become more confident. They have also worked on
Jeremy’s self-care, slowly developing a routine of regular showering and changing his
clothes. The support has also enabled Jeremy to re-build relationships with his parents,
who have expressed their pride in the progress that he has made.
Jeremy now has his own tenancy, although he continues to stay with Tony on a respite
basis when needed. He is no longer heavily involved with the mental health team. Jeremy
has become involved in social events and taken part in new activities that he would
previously have avoided due to his anxieties and fear of crowded places. He recently
attended a charity fish and chip supper with over 100 people. He has also accompanied
Tony on a trip to the jungle in Calais to deliver a caravan and supplies for refugees, which
he says he feels honoured to have been involved in.
41
Tamsin, aged 26, had experienced severe bullying whilst training to be a medic with the
Navy. She was subsequently diagnosed with severe depression, OCD and post-traumatic
stress. Following her diagnosis, Tamsin was allocated a support worker who arranged a
placement in a supported living scheme, where her mental health continued to
deteriorate: “I wasn’t well, I was basically put into the house and left. I ended up taking a
massive overdose and then ended up being sectioned.”
After being discharged from hospital, social workers introduced Tamsin to Rachel and
Colin, who have supported her in a long-term live-in arrangement since 2013. The Shared
Lives supervisor who arranged the placement for Tamsin, felt Rachel would have the
listening skills to support Tamsin through this period of her life. Thinking back to the start
of the placement, Tamsin describes the first weeks as: “amazing – the family were so
welcoming; it was amazing to be part of the family, I settled in really quickly, I didn’t feel
like I was treading on eggshells, there was no pressure. I felt I could approach the carer
and they would be non- judgemental.”
Tamsin describes the ways that Rachel has helped her to manage her OCD in particular: “I
stroke the light switches, its better to laugh about it if I can, I check the doors all the time,
Rachel tells me to leave it and she will check it, this really helps, otherwise I would sit by
the door all night.” She also describes the overall impact that living in the arrangement
has had on her confidence: “I’ve got a strength I’ve never had, I’ve had lots of
encouragement, I’ve talked for hours with the carers, there is no such word as can’t.”
In the time that she has been in the placement, Tamsin has been able to come off her
medication, and her mental health has stabilised, even in the absence of support from the
mental health team: “Rachel has been my mental health team...I’ve not had a dip since
I’ve been here and I’ve learnt to listen to my body.” Tamsin describes feeling a part of the
family, and its ongoing importance for her: “things like Christmas are amazing we get so
many gifts, I never expected it. We all eat dinner together its important as I can chat,
considering it’s their house it’s amazing they are always there for me.” The support has
also enabled her to re-establish contact with her mother, who had previously found it
difficult to come to terms with her illness.
Since starting the placement, Tamsin has completed a Level 2 NVQ and now works parttime. Reflecting on how she has changed throughout the placement she describes a
transformation of her experience: “At the very start of my journey I didn’t want to be in
the world - but since coming into this placement it’s been great…There is hope no matter
how unhopeful you feel. I’ve never looked back its been brilliant.”
42
The examples above show how day support, short breaks and long-term arrangements can
all work to support an improvement in people’s mental health. They have shown how
Shared Lives can work as planned crisis prevention, as a step towards independence and to
maintain stability. Someone with lived experience of mental ill health who has experienced
inpatient stays described how he thinks it has a role in facilitation of hospital discharge:
“When I came out of hospital everything seemed too fast. You either make it or you
don’t and I didn’t. Going back to living on your own can be too hard. Shared Lives could
be a stepping stone.” Person with lived experience of mental ill health
The evidence from interviews, change stories and tentative indications from the outcome
measurement tool data (as discussed in section 6) suggests that Shared Lives can indeed
deliver some very positive outcomes for people with mental ill health in terms of the mental
health and wellbeing.
An important question is what it is about Shared Lives as an intervention that is key to
making this difference. The consistent message, which will come as no surprise to Shared
Lives Plus or the Shared Lives schemes, is that it is the opportunity of being part of a family
or family home that makes the difference.
“It’s better than these respite places, its one person, it’s still a home, still a house.
Mum wouldn’t have gone to a respite place, she prefers one to one. Also we get to
know [carer] and her family, you wouldn’t get that in respite, there would be different
staff. She’s more of a friend than a carer.” Daughter of woman in short break arrangement
“I was welcomed as a family member, their parents come round, I’m mates with their
nephew, I take the dog out for a walk. It’s more of a home than a lodging”. Person in
long-term Shared Lives arrangement
“Shared Lives is a family home, individuals get attention, I can see the benefits of
that… Shared Lives provides that more personal service, a home, a family, support
that’s more tailored” Mental Health team staff
One mental health team Service Manager described how Shared Lives had been able to help
in a difficult situation with a young person with schizophrenia and possible learning
disabilities. The young person’s family had not allowed services in so the mental health
team had not been able to support her. She was placed in a Shared Lives arrangement as an
emergency situation when her mother’s own health broke down. The family started to see
the Shared Lives carer as part of the family and as part of their support network:
“They would keep nurses and social workers at arm’s length and didn’t want them
involved, but the way they took to the Shared Lives carer almost like she was part of
the family and brought her into their circle rather than seeing her as external. They
43
now have that as an ongoing support because that respite, with the Shared Lives carer
will continue when she is discharged.” Mental health team service manager
One final additional aspect to note in this section on wellbeing, though not one of the
outcomes initially identified, was the impact that Shared Lives has on the wellbeing of family
carers. A 23 year old who cares full-time for her mother who has schizophrenia, had had
long periods of being unable to leave her mother alone and was unable to see friends or do
anything for herself to the extent that her own mental health was at risk. Eventually after
coming close to crisis, support kicked in and her mother now has short breaks with a Shared
Lives carer, giving the daughter a much needed break:
“I’m happy we’ve got the help we need after fighting for so long, it was tiring, I wanted
to run away and not come back, I was getting stressed out. Everything is more stable
now.” Daughter of person getting Shared Lives short breaks
This section has illustrated the very positive impact being in a Shared Lives arrangement can
have for some people with mental ill health. It is not an option that will be right for
everyone and we heard of a small number of cases which had not worked out, with the
individual moving on to other forms of accommodation or support. But it is clear that for
some people, at the right point in their mental health recovery, Shared Lives is form of
support that can deliver positive outcomes in terms of mental health and wellbeing.
Recommendation for Shared Lives schemes: Support Shared Lives carers to understand the
principles of recovery so that they continue to offer flexible support to help keep people
well and avoid crisis.
OUTCOME: Shared Lives is part of local mental health promotion and prevention
services/support
This outcome reflects the long-term vision that Shared Lives will become part of the
landscape of mental health services or provision in the local areas. We have seen in
examples described throughout this report that Shared Lives has a potential role to play in
all of the ways described in Section 4:

Planned prevention

Facilitated discharge from hospital

Step towards independent living

Maintenance

Crisis/emergency
44
While the project has demonstrated that Shared Lives can be part of the landscape of
mental health support, and this has started in all of the seven areas, it is not there yet. This
is unsurprising in a short project, but caused frustration to some:
“It’s slow, it’s hard to keep the momentum and enthusiasm going. I want it to be part
of what is normally considered.” Mental Health Trust staff
There is some way to go in all of the areas, but as the number of people experiencing
positive outcomes through being in Shared Lives arrangements increases, as champions of
Shared Lives within mental health teams continue to spread the word, and as health and
social care processes change to incorporate consideration of Shared Lives as an option as
routine, it seems likely that this will start to change.
One concern which was voiced by Shared Lives staff does pose a potential barrier to this
growth. Recognising that some people had improved quite considerably and their mental
health had stabilised, there was concern about whether they would stop being eligible for
funding and lose the Shared Lives support that was so key to their stability. This scenario
had not come about in the period of this project but it is a potential issue that is less likely to
arise with support for people with a learning disability whose support needs may be more
stable over time. This of course is an issue for preventative services in general – despite
emphasis on prevention in the Five Year Forward View for Mental Health8, the difficulty of
balancing statutory obligations with prevention work in local authorities is acknowledged9.
Recommendation for Shared Lives schemes: Change takes time - be prepared for change to
happen slowly, and be patient.
Recommendation for Shared Lives Plus: Continue to promote Shared Lives as an option for
people with mental ill health beyond the project period at national and regional levels to
Shared Lives schemes and in the mental health sector.
OUTCOME: Increased skills, knowledge and contributions of people accessing,
experiencing and delivering Shared Lives
This final outcome cuts across all of the other areas and recognises the broader outcomes
generated through this project – not only for those who are directly receiving support
through Shared Lives but also those delivering Shared Lives as carers, as staff or as
volunteers.
8
The Mental Health Taskforce (2016), The five year forward view for mental health, London: The Mental
Health Taskforce
9
Local Government Association (2016), Adult social care funding: 2016 state of the nation report, London:
Local Government Association
45
In terms of skills and knowledge there has been an increase in knowledge about mental
health both by Shared Lives staff – some of whom have backgrounds or experience in
mental health, but many for whom their experience has been primarily in learning
disabilities – and Shared Lives carers. Most of the schemes now include sections on mental
health in their general Shared Lives carer induction and training processes and schemes are
starting to make use of the mental health training pack for carers developed alongside this
project. Knowledge about mental health extends beyond the staff and Shared Lives carers
however; being supported in families and in the community helps to break down the stigma
of mental health. One Shared Lives carer commented how she thinks it’s been good for her
own sons who also live with her to understand more about the needs of different people. As
a mental health professional comments:
“It doesn’t just benefit the person – there are benefits to the carer, to society, to
community.” Service Manager, Mental Health team
“In residential people are taken around in herds. In Shared Lives they’re living in
normal communities – this is helping to address stigma.” Social Worker
In terms of encouraging contributions, project monitoring for the project has recorded a
total of 35610 social action opportunities. Social action is described as “people coming
together to help improve their lives and solve problems that are important in their
communities”. Within this project examples have included re-establishing contact with the
church, taking a GCSE, joining a gym, visiting Blackpool illuminations and reconnecting with
family.
A total of 45 volunteering opportunities were created as part of this project. This includes
people volunteering to support Shared Lives – for example through promotion, events,
recruitment of carers and being on Shared Lives panels – as well as people in Shared Lives
arrangements volunteering. In one case someone who had spent 18 months in hospital after
being sectioned under the Mental Health Act left hospital to live in a long-term Shared Lives
arrangement. She started volunteering for a charity shop within a matter of weeks of being
in the arrangement.
A particularly positive example of volunteering has been where people with lived experience
of mental ill health have participated on Shared Lives panels to recruit new Shared Lives
carers.
10
Note that social action opportunities are counted every month and this is the total until the end of September – as some
action are recurring this number reflects the number of times people were involved in social action not necessarily new
opportunities
46
“I love doing the interviews, I really feel a part of it. We did interviews with six people
at a time, now who’d have thought [own name] would have done that?... We had a
good day that day, it was really nice and I was glad to be a part of it. I’ve never done
anything like that.” Person with lived experience of mental ill health in a Shared Lives arrangement
One man, who has not been part of a Shared Lives arrangement himself but was invited to
be part of the Shared Lives panel for this project because of his lived experience of mental ill
health, describes the very significant impact the opportunity to use his own experiences to
benefit others has had on him:
“I have turned a corner. Someone’s took a chance on me. I’m not just a mental illness…
It’s the best thing what’s ever happened to me. I treat it like it’s my job… What I’ve felt
ashamed of before is now helping me and helping others, my experiences are useful
and being used.” “I’m loving it, somebody wants my experience, they want to know
what I think, I’ve got something out of the 38 years of having a mental health
problem… It’s given me more confidence, more friends, I feel more independent.”
Person with lived experience volunteering as Shared Lives panel member
Having found that his experience is an asset and that his contributions on the panel are
valued has given this man a confidence he has never had before and he is now thinking
about applying for jobs, something he has not done for years.
Involvement in this project or actions taken as a result of the project has both increased
general awareness of mental ill health and supported people to contribute more widely; the
project has a wider impact than the impact it has directly on the lives of those receiving
support.
Recommendation for Shared Lives schemes: Look for ways of increasing opportunities for
people with lived experience of mental ill health to be involved in Shared Lives.
Recommendation for Shared Lives Plus: Provide some support or guidance around setting
up volunteering opportunities for people with lived experience of mental ill health.
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6.
My Shared Lives Outcomes Measurement Tool
Shared Lives Plus has commissioned the development of a tool to provide a quantitative
assessment of the key impacts of Shared Lives support for individuals. Developed by the
Personal Social Services Research Unit at the University of Kent, the tool has been designed
in consultation with Shared Lives carers, users and schemes. The questions and key outcome
areas have been defined in accordance with the impacts of Shared Lives arrangements as
reported by users. The tool has been designed to be completed as part of current process,
and follows a ‘before-after’ approach where outcomes are captured at baseline (i.e. at the
start of the intervention) and then at later points in time.
It was initially anticipated that one of the key methods for measuring the outcome of
improved wellbeing was the data generated through the My Shared Lives outcome tool. For
reasons described in this section the data from this in terms of the impact on individuals has
been more limited and difficult to interpret than anticipated. In this section we describe the
response to the tool, the limitations and reflect on what the data available indicates bearing
in mind the limitations described.
Response rates
A total of 28 individuals with mental ill health have been recorded on the My Shared Life
dataset, with baseline data recorded for each. The counts from each scheme are shown in
figure 4 below.
Figure 4: Counts from the Shared Lives Schemes
Shared Lives Scheme
Bradford
Derby
East Sussex
Lincolnshire
North Somerset
Rochdale
Telford & Wrekin
Respondents Respondents
with baseline with followdata (n)
up data (n)
1
1
2
1
2
1
15
10
2
0
3
3
3
2
Total
28
18
Responses reflect the experiences of people in the 3 different types of Shared Lives
arrangements, as shown in figure 5.
48
Figure 5: Counts from the Types of Shared Lives Schemes
Type of arrangement
Long Term
Short Break
Day Support
Unknown
Respondents
Respondents
with baseline
with follow-up
data (n)
data (n)
11
5
7
4
6
5
4
4
Total
28
18
Data limitations
The limitations to the data collected through the tool should be noted. Project monitoring
figures indicate that there have been a total of 71 new Shared Lives arrangements as a
result of the project, but survey responses have been collated for 28 people, and just over
half of these are from a single scheme. Some variation is to be expected, since the numbers
of people reached by each scheme will inevitably vary. However, gaps in completion means
that the findings will be less reliable and skewed towards the scheme that has returned a
higher number. In addition, the tool is designed to measure the change occurring over time
for people supported by Shared Lives, with measures repeated on a quarterly basis. In order
to accurately reflect the difference that the support makes to people, this approach relies
on completion of initial questionnaires at the outset to ensure a ‘true’ baseline, yet the data
indicates that some baseline questionnaires have been completed retrospectively and in
some cases more than one year after placements started. Follow-up data is available for 18
individuals, which offers a low base from which to make judgements about the impact of
Shared Lives. It is important to note that this is in part due to the relatively short amount of
time that has elapsed since the start of the project; individuals who entered Shared Lives
arrangements after August 2016 will not yet have been supported for three months (as of
end October 2016). As a result of these limitations any findings based on the data collected
through the tool should be taken as tentative indications only.
My Shared Lives findings
As part of the My Shared Lives outcome tool people were asked how they feel about
different aspects of their lives and their well-being at baseline and the same questions are
repeated at follow-up, after support has been ongoing for some months. Each question has
4 response options, ranging from the worst to the best possible scenario, as illustrated in
the example below:
49
Figure 6: example of question format from My Shared Life tool
How do you feel about choice in your daily life?
I have no choice. It is bad.
I have some choice. But I would like more.
I have enough choice. It's ok.
I have as much choice as I want. It is great.
The graph below shows how many people at follow-up indicated that each aspect has
improved, stayed the same, or worsened. This is based on a simple count of the number of
people whose response was more positive, less positive, or the same, and does not reflect
the extent of that change. The follow-up data presented here draw on responses to the first
follow-up questionnaires recorded and are therefore indicative of the initial impacts of
Shared Lives support for people with mental ill health. Some individuals who have been
supported for longer have completed further questionnaires, but these have not been
analysed since they are few in number (n=4). As more are completed, they will be an
important indicator of whether (and which) impacts are sustained over the longer-term.
Figure 7 Change in respondent feelings in relation to Shared Lives outcome areas
How do you feel about your social life?
7
Do you feel part of the community?
9
How do you feel about the way you spend your time?
Better
4
7
6
4
8
4
How do you feel about your emotional health?
3
5
7
How do you feel about choice in your daily life?
How do you feel about your physical health?
8
4
11
9
No change
3
6
3
Worse
Base: n=18 respondents who completed baseline and follow-up questionnaires
50
Scope for detailed interpretation of these responses and analysis of the extent of the
change is limited due to the low number of responses. Based on these responses, the broad
implication is that Shared Lives support can impact positively in all of these areas. In
particular, it is interesting to note that 9 out of the 18 reported better emotional wellbeing
at follow up. However, it is important to note that within the responses, there were people
who gave the most positive response at baseline and have declined somewhat since then. In
some responses, Shared Lives staff have detailed events that have affected the person’s
response on that particular day. It is therefore difficult to judge whether changes in
responses captured by the outcome measurement tool genuinely reflect the effects of the
support provided, and whether there is any room for improvement, particularly as
fluctuation in responses can in part reflect the instability of a person’s mental health and
their response to their situation at that given time. Furthermore, as one of the Shared Lives
leads highlighted when she voiced concerns about how the tool would reflect people with
mental ill health – for some people with acute mental ill health, maintaining the same level
of emotional wellbeing (i.e. preventing deterioration) can be an extremely positive
outcome. Given the limitations to the My Shared Lives data described above, the findings
should be taken as an early indication of the impact that Shared Lives can have for people
with mental ill health, rather than an assessment of the impact of the project. As further
data is captured this will allow a greater degree of confidence in the results.
The outcomes tool also measures to what extent people feel their Shared Lives carer makes
a difference to their lives in each of the outcome areas. These responses are shown in the
graph below.
Figure 8 Difference that Shared Lives carers make in relation to Shared Lives outcome areas
Social life
2
15
1
Part of community
2
15
1
How you spend your time
2
15
1
Choice in daily life
2
15
1
Physical health
2
15
1
Emotional health
1
No difference at all
16
It makes it better
1
Don't know
Base: n=18 respondents who completed baseline and follow-up questionnaires
51
In all six areas almost all respondents reported that Shared Lives carers made things better.
Importantly, the responses demonstrate that people report that the support does make a
difference even when the response to a particular question is negative – i.e. they may
report poor emotional wellbeing but the carer makes things better in this area. No
individual reported that support from Shared Lives carer makes things worse in relation to
any aspect.
At follow-up, the outcomes tool also asks people in Shared Lives arrangements whether
they feel a part of the family or household (figure 9). The responses were broadly positive,
with 10 people reporting ‘I feel part of the family. It is great.’ and 4 people reporting ‘I feel
part of the family most of the time. It is ‘ok.’ One person said they did not feel part of the
family at all, while one other said they felt part of the family, but not enough.
Figure 9: Whether respondents feel part of the family or not
Do you feel a part of Shared Lives carers family or
household?
12
10
10
8
6
4
4
2
1
1
0
I don't feel part of the
family at all.
I feel part of the
I feel part of the family
family, but not
most of the time. It is
enough. It could be
ok.
better.
I feel part of the
family. It is great.
Base: n=16 respondents who completed baseline and follow-up questionnaires (2 respondents did not answer
this question)
These findings broadly indicate some positive outcomes, in terms of impact on wellbeing,
the difference the Shared Lives carer makes and the extent to which people feel part of the
family. However, at this stage, until a greater volume of data is generated, the rich
qualitative findings reported above provide us with greater insight in all of these areas.
52
Recommendation for Shared Lives schemes: Support Shared Lives Plus to produce high
quality data about the outcomes of Shared Lives through consistent use of My Shared Lives
outcome tool. Having high quality data is crucial for individual schemes, as well as Shared
Lives Plus in order to demonstrate impact to local commissioners.
Recommendation for Shared Lives Plus: Support schemes to understand the importance of,
and increase use of the My Shared Lives tool to ensure it is a reliable measure of outcomes
for people supported though Shared Lives. This evidence of outcomes is crucial to share
with commissioners.
Recommendation for Shared Lives Plus: Continue to monitor the data generated by My
Shared Lives to assess whether it is suited to people with mental ill health.
53
7. The costs of Shared Lives
It was not part of the evaluation brief to conduct a cost-effectiveness or cost benefit
analysis, but in the current climate of increasing pressure on both health and social care, it is
important to acknowledge the importance of support costs when considering Shared Lives
as an option for people with mental ill health.
A number of research studies have found that Shared Lives can be lower cost than
residential care11. However, it should also be noted that a recent attempt to look at the
costs of Shared Lives for older people highlighted that the range of costs across schemes,
the lack of consistent cost information and the difficulty in collecting cost data make it
difficult to estimate true costs12. When the subject of costs came up with the schemes it
broadly reflected these findings. There were examples of Shared Lives being considerably
lower cost than alternative options, for example in one case where a young woman who
had been living in specialist residential care moved into a long-term Shared Lives
arrangement at a weekly saving of £700. However, in the same scheme it was also
highlighted that Shared Lives was higher cost than supported accommodation in the local
area. The schemes reported examples of Shared Lives being lower cost, comparable cost
and higher cost than other options, but as this wasn’t a focus of the evaluation we did not
gather enough information to come to any overall conclusions. Importantly, there was
recognition from mental health professionals that whether higher or lower cost, it was the
better outcomes that it delivers that are important:
“It’s not only one of the cheaper solutions, it’s one of the best solutions” Community
Matron, Mental Health Team
“If a service is worth commissioning it’s better to go with that – it will prevent
spending in the future. We have cheaper respite but its rubbish.” Team Manager, Mental
Health Trust
11
Dickinson, J. (2011) ‘Shared Lives – model for care and support’ in Curtis, L. Unit costs of Health & Social care
2011, Canterbury: PSSRU; Roe, D. (2011), Illustrative cost models in learning disabilities social care provision,
London: Lang & Buisson; Social Finance (2013), Investing in Shared Lives, London: Social Finance
12
Brookes, N. and Callaghan, L., (2014), ‘Shared Lives - improving understanding of the costs of family-based
support’ in Curtis, L. Unit costs of Health & Social care 2014, Canterbury: PSSRU
54
Recommendation for Shared Lives schemes: Consider undertaking a local cost benefit or
cost effectiveness analysis to compare the cost of Shared Lives to other options in your local
area.
Recommendation for Shared Lives Plus: Consider undertaking a national cost benefit or
cost effectiveness analysis for Shared Lives for people with mental ill health.
55
8. Summary: Developing Shared Lives for people with
mental ill health – What works?
We have seen through this report that there is great variation in how Shared Lives has been
delivered to support people with mental ill health across schemes, and there are many
factors which have both challenged and enabled the development of the support for people
with mental ill health. There is variation in: type of arrangement offered by schemes; the
scheme itself (whether independent or local authority); health and social care systems;
funding mechanisms; and the support needs of individuals. As a result of such variation,
there is no one single recommended model of delivery. Instead eight key factors for
supporting the development of Shared Lives as a form of support for people with mental ill
health have been identified as illustrated in the diagram below:
Figure 10: Developing Shared Lives for people with mental ill health – what works?
Getting a
“way-in”
Well
supported
carers
Good
matching
Becoming
part of the
process
Developing
Shared Lives
for people
with mental ill
health - what
works?
Compatible
funding
mechanisms
Having
ambassadors
or champions
Seizing
opportunities,
filling gaps
Flexibility
56
1.
Getting a “way-in” – finding a “way in” to mental health teams in order to promote
Shared Lives to potential referring practitioners is crucial. This could be through
making the most of existing contacts or links, sustained attempts to secure e.g.
invitations to mental health team meetings, or going to the ‘top’ and making
contact with those with more strategic responsibility.
2.
Becoming part of the process – although this can be a challenge, especially for
independent providers, becoming integrated into the process where decisions are
made about support packages (whether this is through being part of panel
meetings, brokerage or being on a preferred provider list) is key to growth
happening at any pace.
3.
Having ambassadors or champions – having enthusiastic ambassadors or
champions within mental health teams can be very effective at promoting Shared
Lives.
4.
Seizing opportunities, filling gaps – making the most of local opportunities such as
gaps in certain types of provision or drives to move away from traditional forms of
support – i.e. fulfilling demand - can lead to growth at a faster rate.
5.
Flexibility – being flexible about the type of arrangement that can be offered, to
whom, and being flexible about the role of Shared Lives (e.g. as planned
prevention, facilitated discharge or maintenance) at least at the early stages of
development can open schemes up to a greater number of opportunities.
6.
Compatible funding mechanisms – although this is not always within control of
Shared Lives schemes, especially in-house local authority schemes, to maximise
opportunities, schemes need to ensure the local funding mechanisms (block
contracts, personal budgets etc.) fit with the schemes processes. Ultimately, being
able to accept all forms of funding through whatever route or mechanism will
maximise opportunities.
7.
Good matching – a fundamental element of the Shared Lives model for people with
all support needs is the importance of good matching between Shared Lives carer
the person being supported, and this is no different for people with mental ill
health. Good matching leads to positive outcomes and referrals follow good
outcomes.
8.
Well supported Shared Lives carers – the Shared Lives carer is key to making a
Shared Lives arrangement work. Good support for Shared Lives carers through
recruitment, assessment, induction and ongoing support through placements
ensure they can fulfil their roles.
57
9. Conclusion and recommendations
This evaluation has found evidence of the positive impact that having support through a
Shared Lives arrangement – whether it is day support, short breaks or long-term
arrangements – can have on the lives of people with mental ill health. We have seen
examples of improvements in general wellbeing and increased participation in community
life, as well as specific examples where people’s mental health has stabilised and hospital
stays have been prevented. The impact goes beyond those in Shared Lives arrangements to
family members of those being supported, Shared Lives carers and their families and
communities that people are supported in. Shared Lives will not be right for everyone, but
for the right person, at the right point in their mental health recovery, Shared Lives can offer
an individualised, person-centred form of support at the heart of the community. As such, it
has the potential to play an important role as one option, among other types of
accommodation, short breaks and day support on offer to people with mental ill health.
Although some of the seven project schemes experienced challenges and frustrations and in
some cases growth was slow, all saw increases in the number of new arrangements for
people with mental ill health and all saw increases in the number of Shared Lives carers
offering mental health support. Some useful lessons have been learnt along the way that
other Shared Lives schemes looking to develop their support for people with mental ill
health can learn from.
To summarise, the recommendations identified in this report are:
For Shared Lives schemes
Recommendation for Shared Lives schemes: Be prepared to be flexible. Offering flexibility
in the ways that Shared Lives can be delivered (by arrangement type, referral route and
funding accepted) will both maximise the opportunities for Shared Lives as an option and
offer more personal individualised support.
Recommendation for Shared Lives schemes: Make the best out of existing links - identify
existing links that people within the Shared Lives team have with mental health teams or
people in strategic roles and start with these.
Recommendation for Shared Lives schemes: Identify Shared Lives champions - harness the
enthusiasm of mental health professionals who have seen the outcomes of Shared Lives and
58
encourage them to be an ambassador or champion for Shared Lives within their teams and
organisations.
Recommendation for Shared Lives schemes: Make use of case studies – when you have a
good story, tell it! Stories help people to visualise what Shared Lives can offer better than a
description of the model. Think about different ways of sharing stories – for example on
your website or through short films.
Recommendation for Shared Lives schemes: Become part of the process – understand your
local commissioning procedures, identify the key mechanisms (e.g. panel, brokerage,
preferred provider lists) and focus on ensuring that the scheme fits with the process.
Recommendation for Shared Lives schemes: Identify decision makers – if referrals have to
come through a care manager, focus attention on promoting Shared Lives to social workers
and mental health teams; in areas of high levels of use of direct payments, focus attention
on promoting Shared Lives to individuals and their families.
Recommendation for Shared Lives schemes: Support Shared Lives carers to see people as
individuals rather than the mental health diagnosis they may have - provide them with
sufficient information about the individual so they can see past the label to the person.
Recommendation for Shared Lives schemes: Continue to raise awareness about mental
health through educating and training Shared Lives carers. Make use of the Shared Lives
Plus training pack for Shared Lives carers.
Recommendation for Shared Lives schemes: Ensure adequate support is provided to carers
– where resources (financial and staffing) are stretched, explore different ways of providing
support e.g. conference calls, webinar training/support, online support.
Recommendation for Shared Lives schemes: Where possible and appropriate provide
people entering into Shared Lives arrangements a choice over their Shared Lives carer.
Recommendation for Shared Lives schemes: Ensure that Shared Lives staff and carers are
aware of all the local options available to people with mental health needs e.g. peer support
groups, recovery colleges, drop-in centres etc., as well as other non-mental health activities
to ensure people in Shared Lives arrangements have full choice.
Recommendation for Shared Lives schemes: Encourage the use of independent advocacy to
support choice around important decisions.
Recommendation for Shared Lives schemes: Support Shared Lives carers to understand the
principles of recovery so that they continue to offer flexible support to help keep people
well and avoid crisis.
59
Recommendation for Shared Lives schemes: Change takes time - be prepared for change to
happen slowly, and be patient.
Recommendation for Shared Lives schemes: Look for ways of increasing opportunities for
people with lived experience of mental ill health to be involved in Shared Lives.
Recommendation for Shared Lives schemes: Support Shared Lives Plus to develop high
quality methods of capturing the outcomes of Shared Lives. Having high quality data is
crucial for individual schemes, as well as Shared Lives Plus in order to demonstrate impact
to local commissioners.
Recommendation for Shared Lives schemes: Consider undertaking a local cost benefit or
cost effectiveness analysis to compare the cost of Shared Lives to other options in your local
area.
For Shared Lives Plus
Recommendation for Shared Lives Plus: Develop guidance or provide support to help
Shared Lives schemes understand the structure of mental health services and who to liaise
with or target.
Recommendation for Shared Lives Plus: Develop a section of the Shared Lives Plus website
dedicated to mental health – tell stories through case studies or short films.
Recommendation for Shared Lives Plus: Develop guidance or provide support for Shared
Lives schemes to better understand commissioning and funding processes.
Recommendation for Shared Lives Plus: Promote and distribute the Shared Lives Plus
training pack for Shared Lives carers.
Recommendations for Shared Lives Plus: Promote the use of independent advocacy to
Shared Lives schemes.
Recommendation for Shared Lives Plus: Continue to promote Shared Lives as an option for
people with mental ill health beyond the project period at national and regional levels to
Shared Lives schemes and in the mental health sector.
Recommendation for Shared Lives Plus: Provide some support or guidance around setting
up volunteering opportunities for people with lived experience of mental ill health.
Recommendation for Shared Lives Plus: Support schemes to understand the importance of,
and increase use of the My Shared Lives tool to ensure it is a reliable measure of outcomes
for people supported though Shared Lives. This evidence of outcomes is crucial to share
with commissioners.
60
Recommendation for Shared Lives Plus: Continue to monitor the data generated by My
Shared Lives to assess whether it is suited to people with mental ill health.
Recommendation for Shared Lives Plus: Consider undertaking a national cost benefit or
cost effectiveness analysis for Shared Lives for people with mental ill health.
61
Appendix- Cabinet Office Shared Lives Plus Mental Health Project - Theory of Change March
2016
The issue: Shared Lives (SL) is not currently well recognised or used as an option for people with mental ill health (MIH)
Assumptions and project rationale
Context
SL is well established for people with other support needs
Evidence shows SL has positive outcomes and can be lower
cost than alternatives
MH policy emphasis on prevention
High pressure on MH services including funding pressure
People with MIH should have choice and control over where they live
SL is a positive and financially viable alternative to other housing
and support options for people with MIH
Being supported through SL will have a positive impact on wellbeing
and MH
Shared Lives Mental Health Project – January to December 2016
Mechanisms/activity
Recruitment and support of more SL carers
Enable existing SL carers to support people with MIH
Promotion of SL for people with MIH
Engaging with the MH sector
Driving/supporting the change
Cabinet Office funding
Support from SL Plus
Peer support and shared learning between schemes
Outcomes
1. Increased capacity within the SL sector to support people with MIH including:
a. More people with MIH in SLs arrangements
b. More and well supported carers
2. Individuals with MIH using SL have:
a. Better choice and control over their lives and their support
b. Improved MH and wellbeing
3. Increased understanding of SL as a viable option for people with MIH in the MH sector including:
a. Greater awareness and understanding of SL among people and organisations working with people
with MIH
b. Better partnerships/relationships with people and organisations working with people with MIH
4. SL is part of local MH promotion and prevention services/support
5. Increased skills, knowledge and contributions of people accessing, experiencing and delivering SL
Longer-term impact
SL is seen, used and
established as an option
for people with MIH
A change in attitude and
mindset around support
and housing options for
people with MIH
Reduced stigma for
people with MIH

Evaluation of the Shared Lives Mental Health Project

Transcription

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